Non-Hodgkin Lymphoma Stem Cell Transplantation

Stem Cell Transplantation for Non-Hodgkin Lymphoma

The Hematology Oncology Department at Cancer Treatment Centers of America (CTCA) treats the various types and stages of non-Hodgkin lymphoma (NHL) with advanced medical therapies. About two-thirds of our NHL patients are in stage III and IV of the disease.

Stem cell transplantation (also called Hematopoietic Progenitor Cell Transplantation) is a common option for patients with relapsed NHL, or for those who have not had an effective response to chemotherapy.

Understanding Stem Cell Transplantation

Stem cells are immature cells that can develop into any of the three main types of blood cells, including white blood cells. In individuals with NHL, white blood cells called lymphocytes reproduce uncontrollably, crowd out healthy cells and form tumors.

A stem cell transplant infuses more healthy blood- forming cells into the body to suppress the disease and restore the immune system. Stem cells can be collected from the bone marrow, circulating (peripheral) blood and umbilical cord blood.

Types of Stem Cell Transplants

There are two main types of stem cell transplants:

Autologous Stem Cell Transplant

In this type of transplantation for NHL patients, stem cells are collected from the patients themselves. The stem cells are then harvested, frozen and stored until needed (in our Stem Cell Processing and Cryopreservation Laboratory), and given back to the patient after he/she has received high doses of chemotherapy and, sometimes, radiation therapy to destroy cancer cells.

Allogeneic Stem Cell Transplant

In this type of transplant, stem cells are taken from a matching donor. Donors may include a relative (most often a sibling), unrelated individual or saved umbilical cord blood. To determine if a donor’s stem cells are the right match, the patient will undergo a human leukocyte antigens (HLA) test. Through this test, we compare the patient’s blood and tissue type against blood samples from the donor.

The Stem Cell Transplantation Process

Before the transplant, you'll typically undergo a conditioning regime, which involves intensive treatment to destroy as many cancer cells as possible. You may receive high doses of chemotherapy, chemoradiation (chemotherapy combined with radiation therapy) or reduced-intensity conditioning (a “mini-allogeneic transplant”). A mini-transplant uses lower, less toxic doses of chemotherapy and/or Total Body Irradiation (TBI) before the transplant.

Once this preparative regime is complete, you're ready to undergo the transplant. Much like a blood transfusion, you’ll receive the stem cells intravenously. The procedure takes about an hour. The transplant restores the supply of normal cells that have been destroyed by the intensive therapies.

After the Transplant

After entering the bloodstream, the stem cells travel to the bone marrow and begin to produce new blood cells in a process known as engraftment. In the months following the transplant, your CTCA doctors will check your blood counts on a frequent basis to monitor this process.

Sometimes, the high doses of chemotherapy and radiation you receive before the stem cell transplant can cause side effects, such as infection. Another risk of allogeneic stem cell transplantation for NHL is graft-versus-host-disease (GVHD), a condition where the donated cells attack the patient’s tissues. Your doctor may prescribe certain drugs to reduce the risk of infection or GVHD.

Helping You Maintain Your Quality of Life

Recovery from a stem cell transplant can take several months. You’ll need support from multiple areas to help reduce treatment-related side effects and maintain your quality of life.

Our hematology oncology team will work closely with the other members of your care team throughout the entire non-Hodgkin lymphoma stem cell transplantation process. The following are examples of how the rest of your care team will support you during this time:

• Your nutritionist will develop a special meal plan to fortify your body after the transplant.
• Your naturopath will recommend natural therapies to help minimize side effects, such as peripheral neuropathy and fatigue.
• Your pain specialist will use various techniques to help alleviate discomfort and control your pain, including bone and neuropathic pain.
• Your mind-body therapist will provide counseling and stress-management techniques so you can relax.
• Your rehabilitation therapist will provide a personalized exercise program to help you stay active and functionally independent.
• Your spiritual counselor will help nurture your spiritual well-being.

Next Topic: Chemotherapy for NHL